Senators seek to fix ER reimbursement loophole for new vets

Oct. 31, 2013 - 10:49AM
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A loophole in veterans’ healthcare that is leaving some Iraq and Afghanistan veterans facing big medical bills for emergency room treatment is under study by a Senate committee and the Veterans Affairs Department.

Fixing the problem has raised larger issues about the long waiting times for initial medical examinations required before a veteran is fully eligible for VA health care benefits.

VA has a requirement, set in law, that prohibits reimbursement of emergency room care at non-VA facilities for anyone who has not had a medical appointment in the previous 24 months at a VA hospital or clinic.

Sen. Mazie Hirono, D-Hawaii, is the chief sponsor of a bill to change that. Her proposal would specifically allow ER reimbursement for veterans who have not had VA medical appointment in the previous 24 months because of the waiting period for new patient examinations.

Republican Sens. Jerry Moran of Kansas and Johnny Isakson of Georgia and Democrat Mark Begich of Alaska are cosponsors of her bill, S 1588.

Hirono said the current policy is well intended, but “it is not fair to punish veterans for waiting times outside their control.”

“Just last week, I met a veteran from Waianae who had a medical emergency while waiting for months for his appointment at VA,” she said Wednesday when her bill was discussed before the veterans’ committee.

Hirono aides estimate that the bill could help 144,000 Iraq and Afghanistan veterans.

“It is unacceptable for veterans to be denied emergency health care coverage because of bureaucratic red tape caused by inefficiencies in VA,” said Isakson.

Earlier this year, VA told Congress that veterans wait an average of 50 days for their new patient examinations, with actual wait times varying by location.

VA is well aware of the problem and has been seeking a fix, but is not quite ready to endorse Hirono’s bill, according to Robert Jesse, the VA health care official who testified at the hearing.

Veterans of Foreign Wars, the nation’s largest organization for combat veterans, does support the bill.

“The strict 24-month requirement is especially problematic for current-era veterans, many of whom have never had the opportunity to be seen at VA facilities due to long appointment wait times, despite their timely, good faith efforts to make appointments following separation,” said Raymond Kelley of the VFW’s national legislative service.

“Under no circumstances should long appointment wait times prevent a veteran from seeking emergency, possible life-saving care at a non-VA facilities or expose that veteran to financial hardship as a result of doing so,” Kelley said.

Disabled American Veterans also supports Hirono’s effort, but has issues with some details. DAV opposes limiting the waiver to new veterans, arguing that the 24-month requirement also discriminates against otherwise healthy veterans who have not sought VA treatment because they haven’tt needed it, said Adrian Atizado, DAV’s assistant national legislative director.